Provider Demographics
NPI:1114999851
Name:DECASTRO, BRIAN JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JOHN
Last Name:DECASTRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2296 OPITZ BLVD STE 350
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3346
Mailing Address - Country:US
Mailing Address - Phone:703-546-4782
Mailing Address - Fax:703-546-4782
Practice Address - Street 1:2296 OPITZ BLVD STE 350
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3346
Practice Address - Country:US
Practice Address - Phone:703-546-4782
Practice Address - Fax:703-546-4782
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101254296208800000X
GA062966208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology